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CHIA Releases Report on Massachusetts Primary Care and Behavioral Health Spending

DATE : August 29, 2024

The Center for Health Information and Analysis (CHIA) today published its latest report on primary care and behavioral health care spending in Massachusetts As key findings show, spending trends on primary care and behavioral health services varied across major insurance categories between 2021 and 2022. 

Primary care and behavioral health are cornerstones of our health care system; these services are known to meaningfully shape patient outcomes and are often associated with lower health care costs and higher quality care. This series is part of CHIA’s efforts to offer policymakers and industry leaders objective data that can be used to track system-wide investments as well as to inform policies and market reforms in these areas. 

This report focuses on spending for primary care and behavioral health services for members enrolled in private commercial, Medicaid MCO/ACO-A, and Medicare Advantage plans for calendar years (CY) 2021 and 2022. New analyses in this report include primary care and behavioral health spending metrics by age group, payer, and managing physician group.

Key Findings: 

  • In 2022, combined spending on primary care and behavioral health services represented 14.3 percent of total spending for commercial members, 27.6 percent for Medicaid MCO/ACO-A members, and 6.4 percent for members enrolled in Medicare Advantage plans.  

  • Commercial primary care per member per month (PMPM) spending was $44 in 2022. Medicare Advantage members had slightly higher primary care spending PMPM at $47, and MassHealth members enrolled in MCO/ACO-A plans had lower primary care spending PMPM at $35. 

  • Medicaid MCO/ACO-A plans had the highest behavioral health PMPM spending at $95 PMPM in 2022. Behavioral health spending was $48 PMPM for commercial members and $26 PMPM for Medicare Advantage in 2022.  
     

Accompanying this report is a detailed databook, a dataset with payer- and provider-specific primary care and behavioral health spending information, and a technical appendix. Visit the Primary Care and Behavioral Health Care (PCBH) Spending report page on chiamass.gov for more information. 

Coming soon! Look for CHIA’s first Behavioral Health Dashboard in September, part of CHIA’s efforts to track the performance of Massachusetts’ primary care and behavioral health systems. This dashboard provides a comprehensive overview of indicators related to behavioral health care access, finance, utilization, quality, and equity in Massachusetts.